Nebosh Igc _ December 2010 Reg. Form

NEBOSH International General

Certificate in Occupational Safety &

Health

06th Dec. 18th Dec. 2010

(12-Day Block Course)

WARRI, NIGERIA

Safetek Consults Limited

Risk Management Consultants

NEBOSH IGC REGISTRATION FORM

Name (Mr./Ms.)

_____________________________________________________________________________________________________________

(First Name) (Middle Name) (Last Name)

Position: ______________________________________________ Organization: ________________________________

Address: __________________________________________________________________________________________________

Telephone: _____________________________________________ Fax: ___________________________________________

Mobile: ______________________________________________ Email: _________________________________________

Date of Birth: _____________________________________ Signature: _____________________________________

For Resit: Please indicate the unit examination(s) for which you would like to register

IGC 1: Management of International Health & Safety

IGC 2: Control of International Workplace

IGC 3: International Health & Safety Practical Application

For further assistance, please contact:

Safetek Consults Limited Office; # 60 Airport Road, Near Oceanic Bank PLC, Warri.

Tel.: +2348025436653 e-mail: (info@safetekconsults.com), Val. on 00971 50 7948739

(v.obi@safetekconsults.com), Toks on 00971507983504 (a.adeyemo@safetekconsults.com).

NB: Completed form to be submitted with photocopy of international Passport or National ID Card or National Drivers licence

Deadline for registration is 20th of October 2010, with 70% of Course fee.